tbuckley/cabot-search huggingface dataset:
Abstract 13748: The Relationship Between Anxiety, Cumulative Social Risk, and Adherence to Antihypertensive Medications
Authors: Onoriode Kesiena, Mehdi Rizvi, Kobina Hagan, Shreyas Singireddy, Kofi D Seffah, Aysha Allahverdiyeva, Jacob Braunstein, Navin Kumar, Temitope Olokunlade, Garima Sharma, Elias Mossialos, Khurram Nasir
Journal: Circulation (2022)

Introduction: Psychiatric disorders and social determinants of health impact the management of medical conditions. We examined the relationship between anxiety, cumulative social risk, and adherence to antihypertensive medications. Methods: We used data from the 2020 national health interview survey to evaluate antihypertensive medication use. Anxiety and use of anxiolytics were the independent variables. Cumulative social risk (CSR) was made up of a composite of economic stability, education, food insecurity, neighborhood, and health care system. Four quartiles were created, with the highest (4 th ) CSR quartile denoting the least social risk. Logistic regression was used for the analysis. Results: Of the 10,499 participants with hypertension, 8772 (80.2%) of were taking hypertensive medications. The mean (SE) age of the sample was 60.4 (0.23) years and 50% were females. Among those on antihypertensives, 16.2% reported anxiety and 68.0% reported using anxiolytic medications. Distribution of CSR is as shown in figure 1. Among those with anxiety, the odds of taking antihypertensive medications reduced as the CSR quartile increase from 2 nd [AOR 0.42; 95% CI 0.18, 0.96. p=0.039], 3 rd [AOR 0.38; 95% CI 0.18, 0.83. p=0.016] to 4 th quartile [AOR 0.34; 95% CI 0.13, 0.88. p=0.026] as compared to 1 st quartile. Among those on anxiolytic medications, belonging to CSR 4 quartile had a reduced [AOR 0.21; 95% CI 0.08, 0.58. p=0.003] as compared to the CSR 1 quartile. Conclusions: Individuals with anxiety with the least CSR are less likely to be taking antihypertensive medications. This may be related to an increased likelihood of a healthier lifestyle.
Abstract 13106: Prevalence, Characteristics, and Outcomes of Atrial Fibrillation Patients Attended by Emergency Medical Services
Authors: Jocasta Ball, Emily Mahony, Emily Nehme, Ziad Nehme, Dion Stub, Karen Smith
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) remains the most common sustained cardiac arrythmia and is a growing burden on healthcare resources, despite improvements in prevention and management. AF is a common cause of hospitalisation, and for acute episodes, patients often contact Emergency Medical Services (EMS) for treatment and transport. However, there is a paucity of data describing the burden of AF presentations on EMS. Aims: To determine prevalence, characteristics, and outcomes of patients presenting with AF attended by EMS using a large population-based sample. Methods: Consecutive EMS attendances for AF in Victoria, Australia from January 2015 to June 2019 were included if patients had a diagnosis of ‘AF’ or ‘arrhythmia’ with AF on electrocardiogram. Data were individually linked to emergency, hospital admission, and mortality records. Results: AF was the reason for emergency ambulance attendance in 23,925 of 2,237,145 cases (1.1%). Median (IQR) age was 76 (66,84) years and 57% were female. Eighty-four percent of patients had a high thromboembolic risk (CHA 2 DS 2 -VASc score ≥2), 73% had a heart rate &gt;100bpm, and &gt;50% were normotensive (mean SBP 133 ± 28mmHg). Forty-four percent of patients received no medical intervention by paramedics and 98% were transported to hospital. From the Emergency Department, 19% of patients were discharged home, 36% went to a short-stay unit, 34% were admitted to a general medical ward, and 7% were admitted to a coronary care unit. Median (IQR) length of stay for those admitted was 1 (1,4) day. Of 5,000 cases reattended for AF during the 4.5 year study period, 22% of reattendances occurred within 30 days and 34% within 6 months of the index event. Overall, 22% died during the study period, 37% of those within 6 months of the index event. Conclusions: EMS utilisation for acute episodes of AF is common and associated with many reattendances. Further studies are required to investigate novel pathways of care to reduce AF burden on healthcare systems.
Abstract 13225: Frailty Screening at Scale Using Core Clinical Data and Supervised Machine Learning
Authors: Rosie Fountotos, Jonathan Afilalo
Journal: Circulation (2022)

Introduction: Frailty is a major risk factor for adverse health events in older adults with cardiovascular disease. Hypothesis: We sought to develop and validate a predictive model leveraging data available in the electronic health record to screen for frailty as defined by a prospective reference standard. Methods: We conducted a population-based cohort study using data from the Canadian Longitudinal Study of Aging (CLSA). From 2010-2015, the CLSA enlisted a diverse and multi-ethnic sample of community-dwelling adults 45-85 years of age. Comprehensive phenotyping was performed through interviews at participants’ homes and assessments at data collection sites. Frailty was quantified by the 47-item Frailty Index (FI) Examination, consisting of tests for age-related deficits in physical performance, body composition, cardiovascular and pulmonary physiology, cognitive and sensory function. After dividing our sample into training (80%) and test (20%) sets, we compared machine learning and linear regression models to predict the FI based on age, sex, comorbidities, and blood test results. We used the H2O AutoML platform (DAI 1.10.2) to iteratively determine the optimal model. Results: The cohort consisted of 30,097 adults with a mean age of 63±10 years and 51% females. The mean FI score was 0.28±0.08 (best-worst 0.07-0.70). The gradient-boosted machine learning model achieved an R 2 of 0.512 and a root mean squared error (RMSE) of 0.058 to regress FI scores, and an area under the curve of 0.766 to classify FI quintiles, selecting the following 10 variables in descending order of importance: age, chronic heart failure, hypertension, glycated hemoglobin, high-sensitivity C-reactive protein, high-density lipoprotein, red cell distribution width, vitamin D, female sex, and diabetes. The linear regression model achieved a similar R 2 and RMSE with all 62 input variables and a modest decline after selecting the top 10 input variables using a leaps-and-bounds algorithm. Conclusions: Frailty screening can be performed at scale for clinical or research purposes using common clinical and biochemical inputs. Our machine learning model predicted frailty with a manageable number of inputs and yielded pathophysiological insights about their relative importance.
Abstract 13090: Not Your Simple Swimmer’s Ear: Ramsay Hunt Syndrome Complicated by Gradenigo Syndrome, Varicella Zoster Meningoencephalitis, and Superimposed Bacterial Necrotizing Otitis Externa in a Heart Transplant Patient on Chronic Immunosuppression
Authors: Kevin Benavente, Landon Kozai, Krixie Silangcruz, Julian Rimm, James Zhang, Lisa Kim, Dipanjan Banerjee
Journal: Circulation (2022)

Introduction: Orthotopic heart transplantation (OHT) increases the risks of varicella-zoster reactivation, and severe complications may arise due to infection in the setting of active immunosuppression. Complications include meningitis, facial nerve palsy (known as Ramsay Hunt Syndrome), and bacterial superinfection. When severe bacterial ear infections spread to the petrous apex, facial pain accompanied by otitis media and abducens nerve palsy may also occur, classically known as Gradenigo Syndrome. Case Report: We present a case of a patient 15 months post OHT who came in with left-sided facial droop and pain, abducens palsy, crusting facial rash, and ear swelling. Imaging revealed necrotizing otitis externa, with associated otitis media, petrous apicitis, and signs suggestive of encephalitis. A viral panel resulted positive for zoster infection, with superimposed methicillin-resistant staphylococcus aureus infection. Despite treatment with antibiotics and antivirals, the patient's mentation declined, with subsequent lumbar puncture revealing zoster meningoencephalitis. The patient’s mycophenolate mofetil (MMF) immunosuppression was suspended, and he was continued solely on therapeutic tacrolimus. His antiviral was switched to intravenous acyclovir and he was continued on six weeks of antibiotic therapy. The patient demonstrated resolution of his acute infection, however he continues to have residual facial and abducens nerve palsies. On discharge, the patient was resumed on MMF without any cardiac complications. Conclusions: This is the first documented case of Ramsay Hunt Syndrome, complicated by Gradenigo Syndrome and varicella-zoster virus meningoencephalitis in an OHT recipient. Our patient's immunosuppression level was the most important factor leading to the concurrence of these novel complications. Physicians should consider and assess for symptoms of these potential sequelae in all transplant patients, and carefully manage immunosuppressive agents to allow for resolution of the infection, while avoiding rejection. While residual neurologic deficits may be challenging to manage, this case demonstrated successful treatment of these complications while avoiding significant cardiac sequelae.
Abstract 13035: Mechanical Circulatory Support is a Viable Solution for Adults With Failing Fontan Circulation
Authors: Kengo Z Soghoyan, Stephen Cook, Maya Guglin
Journal: Circulation (2022)

Mechanical circulatory support (MCS) is rarely used in adults with congenital heart disease and even more uncommon among those with single ventricle (e.g. Fontan) circulation. As survivorship among Fontan patients increases, evaluation for MCS is warranted. This systematic review’s objective is to study the outcomes of adult Fontan patients supported by MCS. METHODS We searched the literature in English in PubMed and Google Scholar in May 21 &amp; 2, 2022 using MeSH terms: "VAD," "Fontan," and "circulatory assist device." The search yielded 2785 results. After screening for title, abstract, patient age (&gt;18 y/o), and extractable individual patient data, 23 reports met the criteria. Ultimately, 15 full texts were reviewed and included in this report. RESULTS We identified 18 patients on MCS, including 7 on short-term devices (Impella), 4 on paracorporeal pulsatile devices (PPDs), and 7 on durable continuous flow ventricular assist devices (VADs). Short-term pumps were used for cardiogenic shock (5, with 3 survivors) or support of high-risk ablation procedures. PPDs were used as a bridge to transplantation, mean patient age of 23.5±3.4 years old; all survived after a mean time on MCS of 172±158 days.In the VAD cohort (7 patients, 85.7% males, age 25.1±4.0), 5 received Heartmate 3, one received Heartmate II, and one Heartware (Table 1). Indications for VAD included cardiogenic shock (4 patients, 2 on VA ECMO) or heart failure. VADs dramatically increased cardiac index from 1.6±0.14 to 3.6±0.1 L/min/m2, p=0.0003, and decreased Fontan pressure from 21.4±3.3 to 13.0±1.4 mmHg, p=0.02. Heartmate 3 mean speed was 6460±568.3 rpm. All patients survived, with mean time on VAD lasting 459.5±452.2 days. CONCLUSIONS Implanted mostly for catastrophic indications, adult Fontan patients demonstrated improved hemodynamics and excellent survival following MCS use. These improvements are promising, and earlier implantation prior to catastrophic events may lead to better outcomes.
Abstract 13635: Blunted Vascular Endothelial Function in Black Females: Examining the Impact of Psychosocial Stress Exposure versus Internalization and Coping
Authors: Zachary T Martin, Iman O Aldaas, Natalia Cardenas, John O Kolade, Emily R Merlau, Joshua Vu, Kyrah K Brown, Robert M Brothers
Journal: Circulation (2022)

Introduction: Among females in the United States, Black females suffer from the highest rates of hypertension, coronary artery disease, and total cardiovascular disease (CVD) mortality. Vascular endothelial dysfunction precedes overt CVD and predicts CVD risk and has been reported in this population, but this is not always a consistent finding. Although psychosocial stress from numerous sources likely contributes to this disparity, the precise pathways and mechanisms remain incompletely understood. A growing literature suggests that internalization and coping may be more important than exposure to stressors alone. Therefore, we examined the relationship between endothelial function (brachial artery flow-mediated dilation, FMD) and psychosocial stress exposure (adverse childhood experiences, ACEs; past week discrimination, PWD) versus internalization/coping (John Henryism Active Coping Scale, JHAC12; Giscombe Superwoman Schema Questionnaire, G-SWS-Q). We hypothesized that 1) FMD would be blunted in Black relative to White females and 2) among Black females, internalization and maladaptive coping would exhibit a stronger negative relationship with FMD than exposure to stressful experiences alone. Methods: Twelve Black (21 ± 3 yr) and 8 White (25 ± 6 yr) healthy females underwent standard FMD testing. Black participants completed the ACEs, PWD, JHAC12, and G-SWS-Q inventories. Higher scores indicated greater stressor exposure or endorsement of the internalization/coping constructs. Results: Brachial artery FMD was lower in Black relative to White females (4.93 ± 3.10 vs 8.58 ± 1.62%; p &lt; .01). Neither ACEs ( r = -.10, p = .75) nor PWD ( r = -.24, p = .45) were associated with FMD. JHAC12 scores were ( r = -.61, p = .02) and SWS scores tended to be ( r = -.39, p = .11) negatively associated with FMD. Among the SWS subscales, SWS-Resistance to Being Vulnerable ( r = -.51, p = .04) and SWS-Intense Motivation to Succeed ( r = -.54, p = .04) were negatively associated with FMD. Conclusion: These preliminary data indicate that 1) brachial artery endothelial function is blunted in young Black females and 2) reduced vascular function in Black females may be due more to internalization and maladaptive coping than exposure to stressful experiences alone.
Abstract 14006: Circulating microRNAs Predict Recovery in Pediatric Dilated Cardiomyopathy Patients
Authors: Shelley D Miyamoto, Steven E Lipshultz, Bonnie Neltner, Taye Hamza, James D Wilkinson, Anis Karimpour-Fard, Steven Colan, Carmen C Sucharov
Journal: Circulation (2022)

Introduction: microRNAs (miRs) are small single stranded RNAs capable of targeting expression of several genes. Circulating miRs are stable and can be important biomarkers of disease progression and diagnosis. Hypothesis: We hypothesized circulating miRs could be a reliable prognostic biomarker of recovery for pediatric dilated cardiomyopathy (DCM). Methods: TaqMan Open Array miR panel (ThermoFisher Scientific) was used to investigate expression of 381 circulating miRs. Samples originated from the Pediatric Cardiomyopathy Registry (PCMR) and were collected within 3 months of a new diagnosis of DCM. Inclusion criteria included &lt;18 years of age at diagnosis of idiopathic or familial DCM (EF&lt;50% or left ventricular end-diastolic dimension [LVEDd] z-score ≥+2). Patients with DCM secondary to musculoskeletal diseases or anthracycline toxicity were excluded. Primary outcomes, occurring within 1 year of enrollment, were defined as: [1] Death, transplant (tx) listing or initiation of mechanical circulatory support; [2] Recovered- normalization of ventricular size and function (EF≥50% and LVEDd z-score &lt;+2) or [3] Stable- persistent DCM with EF&lt;50% or LVEDd z-score ≥+2. Statistical analysis included random forest, hierarchical clustering and area under the receiver operator curve (AUC). Results: N=10 subjects were included in Group 1, of which 70% were female, 6 were white, 2 Hispanic and 3 of other/unknown races, median age 9.5y. N=5 samples were included in Group 2, of which 60% were female, 3 were white, 1 black and 1 native American, median age 1.9y. N=20 samples were included in Group 3, of which 40% were female, 10 were white, 5 black, 1 Pacific islander, 2 Hispanic and 4 of other/unknown races, median age 2.1y. The top 3 miRs differentiating Group 2 (Recovered) from Group 1 (Death/Tx) (AUC of 0.92) were hsa-miR-655, -410 and -636. The top 3 miRs differentiating Group 2 (Recovered) from Group 3 (Stable) were hsa-miR-17, -410 and -345 (AUC of 0.76). Conclusions: These results indicate circulating miRs can predict recovery in the pediatric DCM population. A unique biomarker signature of miRs specific to patients who have the potential to recover would improve risk stratification of this population.
Abstract 13221: A Multidisciplinary Approach to Transvenous Lead Extraction in the Setting of a Large Patent Foramen Ovale
Authors: Susan Keen, Mehak Dhande, Amr F Barakat, Catalin Toma, Anson J Smith, N A Estes, Alaa Shalaby
Journal: Circulation (2022)

Introduction: Increasing cardiovascular implantable electronic devices (CIED) implantation has been associated with a rising incidence of CIED infection. Treatment includes targeted antimicrobial therapy and device hardware removal although larger lead vegetations have historically undergone surgical removal. As many CIED recipients are at high surgical risk, there is growing need for transvenous approaches for safe debulking of vegetation mass. Case: An 80-year-old man with a history of ischemic cardiomyopathy and an indwelling dual chamber implantable cardioverter defibrillator (ICD) for 17 years with previous appropriate shocks was found to have Enterococcus faecalis bacteremia. Transthoracic echocardiography revealed a 3 cm vegetation on the right ventricular lead involving the tricuspid valve in addition to a large patent foramen ovale (PFO). He was started on intravenous antibiotics. Blood cultures revealed no growth. Decision-making: The large-sized vegetation in presence of a PFO posed a risk for pulmonary or systemic embolization from transvenous lead extraction. A multidisciplinary approach was developed which included temporary PFO occlusion, thrombus aspiration with the Inari FlowTriever thrombus aspiration system, and transvenous laser lead extraction (Figure 1). No residual material remained and the Amplatzer was retrieved. Cultures from the pocket, lead tips, and vegetation were collected. The vegetation culture grew E. faecalis. He underwent subcutaneous ICD implant six weeks later following antibiotic therapy. Conclusions: Vegetation suction with a simple handheld device can be safe and effective for vegetation removal in high-risk cases. Furthermore, temporary PFO occlusion can be performed during vegetation debulking and device extraction. These management strategies may gain wider application with an increasing need for lead extraction in older patients with comorbidities that preclude surgical candidacy.
Abstract 13358: A Platform for the Personalized Management of Diabetes and Cardiovascular Disease at Population Scale With Data From Multiple Sensors
Authors: Ransalu Senanayake, Johannes O Ferstad, Isha Thapa, Flavia Giammarino, Megana Vasu, Dessi Zaharieva, Priya Prahalad, David M Maahs, David N Rosenthal, Fatima Rodriguez, Nicholas Bambos, Daniel Miller, Andrew Shin, Stephen J Roth, Carlos Guestrin, Emily B Fox, David Scheinker
Journal: Circulation (2022)

Introduction: The American Heart Association has identified the design of mobile health (mHealth) tools to improve the management of diabetes and cardiovascular disease and to prevent unplanned hospital readmissions as a priority. Methods: We developed HEART, an open source platform for personalized telehealth at population scale based on data from internet-connected health sensors and data extracted from the electronic medical record (EMR). Health sensors include scales, blood pressure monitors, activity monitors, continuous glucose monitors, and insulin pumps. EMR data include gender, age, race, reason for admission, all surgical procedures performed, and all medications prescribed upon discharge. We collected admission and readmission data for all cardiology patients at an academic pediatric medical center over the last 7 years. Results: HEART has five independent modules (Figure): 1) a data processing module that pulls data in from a variety of devices and EHR feeds, 2) an algorithm module that identifies reasons why a provider may want to contact a patient and ranks patients for contact, 3) a visual interface module that summarizes population data and provides additional details for patients selected by the provider, 4) an intervention module that facilitates messages being sent to providers and documented in the EMR, and 5) a user tracking module that monitors providers use. HEART ranks the entire population cared for by a clinic and allows providers to identify easily those patients who may benefit most from a secure message, telemedicine contact, or in-person visit. There were 5,011 admissions to cardiology among 2,916 patients, with 1000 urgent readmissions for 512 patients and 35,300 outpatient clinic visits. Conclusions: HEART is a population-level framework to facilitate personalized mHealth with data from a variety of sensors and EMR data feeds. It may facilitate outpatient monitoring as part of an effort to prevent unplanned hospital readmission.
Abstract 13030: Non-Exercise Machine Learning Model for Maximal Oxygen Uptake Prediction in National Population Surveys
Authors: Yuntian Liu, Chenxi Huang, Bobak J Mortazavi, Rohan Khera, Harlan M Krumholz, Yuan Lu
Journal: Circulation (2022)

Introduction: Maximal oxygen uptake (VO 2 max), an indicator of cardiorespiratory fitness (CRF) requires exercise testing and, as a result, is rarely ascertained in large-scale population-based studies. There are many non-exercise algorithms that can estimate VO 2 max, but they are limited by their non-representative study population, lack of predictors, and the insufficient predictive power for the type of model chosen. In this study, we aim to improve the non-exercise algorithms using machine learning (ML) methods and data from U.S. national population surveys. Methods: We used the 1999-2004 data from the National Health and Nutrition Examination Survey (NHANES) because it included exercise testing to measure VO 2 max. Based on the literature review, predictors were identified from demographic, interview, examination, and laboratory data. The study population was split into a training set (80%) and a testing set (20%) for model development and validation. We built the improved model using Light Gradient Boosting Machine (LightGBM) for its outstanding performance and built-in functionality for handling missingness. The model was trained by optimizing Root-Mean Squared Error (RMSE) and using 5-fold cross-validation. Existing non-exercise algorithms for comparison were applied to the testing set. Results: Among the 5,668 participants included, the mean age was 32.5 and 49.9% were women. 40 predictors in total were selected for the final feature set. The fitted LightGBM model achieved an RMSE of 8.43 ml/kg/min (95% CI: 7.64 -9.19) on the testing set, significantly reducing the error by 14% (P &lt;0.05) compared with the best existing non-exercise algorithms that could be cross-validated in NHANES (Table1). Conclusion: In conclusion, the extended non-exercise ML model in this study can provide a more accurate prediction of VO 2 max for NHANES participants, and those with similar data, than the existing non-exercise algorithms.